Background and Objectives: Thrombolysis of Isolated calf vein thrombosis (CVT) is not clearly studied. We investigated the thrombi in patients with deep vein thrombosis (DVT) from the initial time of diagnosis using ultrasonography (US). Methods: Of the 2,299 consecutive patients undergoing venous US between October 2010 and March 2015, we enrolled 198 patients with DVT who were monitored using US from the initial time of diagnosis (mean follow-up was 156±210 days). The patients were devided into three groups according to the segment of thrombi, ilio-femoral (group I), femoro-popliteal (group F) and localized calf (group C). Results: Thrombolysis occurred in 39 limbs in group C, 21 limbs in group I and 24 limbs in group F (p=0.034). In group C, reduction in thrombus size occurred 64.1% after over 30 days follow-up (p=0.029). Conclusion: In patients with CVT, long term follow-up with US is beneficial compared with proximal DVT.
Thoracic aorta mural thrombus (TAMT) in proximal descending aorta caused multiple embolisms including multiple brain infarction and superior mesenteric artery embolism (SAME), concomitantly. An open stent graft implantation (OS) was performed successfully, to avoid recurrent embolism 3 weeks after the onset. Considering a surgical intervention to TAMT at aortic arch or around, Thoracic endovascular aortic repair (TEVAR) is thought to be the most favorable choice, currently, but to have a potential risk of a procedural embolism. We think that OS may be a choice in the case of large thrombus at aortic arch or around.
An-84-year old woman presented pain, coldness and hypesthesia in both hands and was reffered to us for necrosis of the left 3rd finger. CT angiography revealed occlusion or severe stenosis from both subclavian artery to brachial artery. Because of expansion of necrosis, ascending aorta-bibrachial artery bypass grafting using composite Y-type artificial vessel and great saphenous vein was performed. Postoperative course was good and it is useful method incase of severe upper limb ischemia with occlusion of both vertebral artery.
An 82-year-old woman started receiving hemodialysis when she was 71 years old. She underwent a balloon angioplasty for right subclavian venous stenosis with vascular access limb swelling. The subclavian vein was ruptured and occluded, and the right upper limb swelling worsened. A vascular access could not be used, so insertion of a catheter in the left subclavian vein was needed. Hence, she was referred to our hospital. She underwent right cephalic vein-right internal jugular venous bypass with a saphenous vein graft.